肺切除术后支气管胸膜瘘的原因分析和处理  

Factors and managements for bronchopleural fistula after lung resection

作　　者：王涛[1] 朱余明[2] 高文[2] 姜格宁[2] 聂运祥[3] 姜福胜[1] 戈烽[1] 

机构地区：[1]首都医科大学肿瘤学系临床肿瘤中心北京世纪坛医院胸外科,北京100038 [2]上海同济大学附属肺科医院胸外科,上海200433 [3]江西省九江市第三医院胸外科,江西九江332000

出　　处：《中国现代医学杂志》2009年第15期2375-2377,2380,共4页China Journal of Modern Medicine

摘　　要：目的回顾性分析肺叶或全肺切除术后支气管胸膜瘘的临床资料和经验体会。方法总结1996年6月～2007年7月间行肺叶或全肺切除术后并发支气管胸膜瘘(BPF)65例。其中男∶女为54∶11。年龄为30～75岁,平均53.76岁。肺癌59例(90.4%),肺结核4例(6.2%),毁损肺2例(3.4%)。行左肺叶切除5例(7.7%),左全肺切除14例(21.5%),右肺叶切除14例(21.5%),右全肺切除32例(49.3%)。结果14例(21.5%)患者予行2次开胸瘘口修补加带蒂肌瓣或大网膜填塞;26例(40.0%)患者行胸廓改形术;19例(29.2%)患者带胸腔引流管出院,其中7例(10.8%)行胸壁开窗引流,12例(18.5%)患者失随访。6例(9.2%)患者因并发呼吸衰竭、全身衰竭在医院内死亡。结论肺叶或全肺切除术后支气管胸膜瘘是严重的并发症,需要警惕各种危险因素。[Objective] Brochopleurat fistula after lung resction is a fatal complication. The aim of this study was to analyse factors and managements for bronchoplueral fistula （BPF） after lung resection. [Methods] 65 patients who underwent lung resection at the Shanghai Pulmonary Hospital and Beijing Shijitan Hospital from June 1996 to July 2007 surfeited brenchoplueral fistula. They were 54 males and 11 females. Ages ranged from 30 to 75 years （median 53.76 years）. Indication for resection was primary malignancy in 59 patients, pulmonary tuberculosis in 4 patients, destructive lung in 2 patients. [Results] Of the 65 patients with bronchopleural fistula, 26 healed well who underwent the reoperation including closure of fistula by omental flap, muscle flap or limited thoracoplasty. 19 patients who were discharged from hospital with chest tube, of whom 7 had the second stage performed and the chest was left open, of whom 12 failed to follow-up. 6 of 65 patients with this complication died due to respiratory failure （mortality rate, 9.2%）. [ Conclusions] A BPF is a life-threatening complication after lung resection. The key to treatment for a BPF is prevention. Prevention depends on meticulous intraoperative technique and the recognition of the risk factors.

关 键 词：肺切除 支气管胸膜瘘 预防 

分 类 号：R562.24[医药卫生—呼吸系统]